Tag: Medicare Fraud Lawyer

You might have heard about a few Medicare fraud cases here and there, but you probably don’t realize how big the problem is. Did you know Medicare and Medicaid fraud costs taxpayers billions of dollars every single year? Or, that an estimated 10% of Medicare and Medicaid claims filed are fraudulent? It’s true. And in the current economic climate, our government hardly has billions to spare.

This is what makes whistleblowing so powerful, and why the government continues to offer rich payouts to individuals who file qui tam lawsuits. As the primary remedy for fraud and false claims, they offer as much as 30% of the amount recovered to the party who filed suit. As you’ll see below, this can end up being quite lucrative under the right circumstance.

History: Medicare Fraud Cases in 2013

At the time, 2013 was a banner year for fraud recoveries. Efforts netted over $3 billion for the federal government, of which over 85% was related to health care fraud. These cases netted significant dollars for the state as well: $443 million went directly back to Medicaid as a result of these recoveries.

Most of the fraud pertained to drugs and medical devices covered under federally insured health programs specifically focused on the improper promotion of drugs for uses not tested and approved by the FDA. Abbot Laboratories, Inc. paid $1.5 billion to resolve allegations against a dementia drug, with $800 million being comprised of federal and state civil recoveries.

History: Medicare Fraud Cases in 2014

In 2014, over seven hundred whistleblower lawsuits were filed on behalf of the government. This was also the first year in which recoveries exceeded $5 billion (it was $5.69 billion, to be exact). Of this amount, $2.3 billion was related to federal health programs like Medicare and Medicaid; the fifth straight year the department netted more than $2 billion in this arena.

Johnson & Johnson, along with its subsidiaries, paid $1.1 billion to settle claims of off-label prescription marketing. Omnicare came in a distant second, paying $116 million to resolve allegations of an illegal kickback scheme.

History: Medicare Fraud Cases in 2015

While much less than 2014, the Justice Department still clocked a cool $3.5 billion as a result of judgments in civil cases pertaining to false claims. This was also the fourth year in a row that Justice beat the $3 billion mark. Since the tightening of legislation back in 2009, a grand total of $26.4 billion has been recovered under the False Claims Act.

Nearly two-thirds of the recovered monies in 2015 were a result of claims related to federal health care fraud. There were a few large settlements, but nothing as large as previous years:

DaVita paid $450 million to settle claims it generated unnecessary waste and billed the government for costs that could have been avoided.

DaVita also spent $350 million to settle claims it paid kickbacks to physicians in exchange for positive clinic referrals.

500 different hospitals settled for $330 million after allegedly implanting cardiac devices in Medicare patients, contrary to the established rules and regulations.

Wondering If You’ve Got a Medicare Fraud Case?

Still have questions about Medicare fraud cases? Call 770.643.1606 to contact the Bothwell Law Group online.

In an attempt to simplify and encourage more citizens to blow the whistle on Medicare fraud, Medicare whistleblower hotlines have been set up throughout the country. The purpose of a Medicare whistleblower hotline is to provide an easy and anonymous way for employees to report evidence of suspected illegal activity within their workplace.

#1. Billing for a service that was not provided.

A healthcare provider may be routinely billing for procedures, most commonly diagnostic tests, that they have not provided to a patient. When the patient receives the incorrect statement, they typically call their provider first instead of Medicare that allows for this type of fraud to go unnoticed.

#2. Billing for supplies that were not provided.

Similarly to the scenario above, some providers may routinely bill Medicare for a supply under the false pretense that they have supplied it to a patient.

#3. Up-coding to be reimbursed at a higher rate.

Some healthcare providers may make a habit of up-coding, or billing a service as a higher paid procedure or test that was not performed. As an employee, reporting this type of fraud is incredibly important since an estimated 2% of Medicare claims are audited for up-coding.

#4. Misrepresenting a diagnosis or procedure.

If a procedure is not covered under Medicare, some healthcare providers will code it inaccurately to obtain reimbursement for that service. Additionally, since Medicare can only cover services that have been deemed as absolutely medically necessary, some healthcare providers will misrepresent a diagnosis as a way to obtain reimbursement for a service that would not be covered under normal circumstances.

#5. Billing bundled services individually.

There are multiple services, especially surgical or diagnostic services, that are bundled together to be billed as one service. In some cases, providers are unbundling these services and billing them separately across several bills as a way to receive additional compensation for a service provided.

The desire to submit an anonymous tip concerning Medicare fraud is completely understandable as many employees fear retaliation at the hands of their employer. However, there are laws in place that protect whistleblowers from retaliation. Although an anonymous call to a Medicare whistleblower hotline is helpful, lawsuits presented with evidence of fraud are more highly prioritized by the government and anonymous whistleblowers cannot be rewarded if the defendant is found liable.

Bothwell Law can assist you in filing a Medicare False Claims lawsuit and teach you what you need to know to protect yourself from retaliation. Find out what you need to know about the Medicare whistleblower hotline by clicking this link or calling 770.643.1606.

Despite the historical number of Medicare fraud arrests, more are set to come.

According to Modern Healthcare reporter Lisa Schencker, “Federal officials announced Thursday the largest coordinated, criminal Medicare fraud takedown—and the first large-scale effort to focus on Medicare Part D fraud—in the history of the U.S. Justice Department.

Over the last three days, the Medicare Fraud Strike Force has unveiled charges against 243 individuals across the country accused of falsely billing $712 million to Medicare in a number of separate schemes, said U.S. Attorney General Loretta Lynch. Those charged include 46 doctors, nurses and other licensed medical professionals.”

Of those arrested, more than 44 have been charged with fraud related to Medicare’s drug benefit program – Medicare Part D.

HHS Inspector General Daniel Levinson said costs in Medicare Part D reached $121 billion last year. “Our focus on Medicare Part D continues because more than 41 million Americans depend on that program, and its integrity must be protected,” Levinson said.

Law firms, like Health Law Partners, are starting to see a lot of fraud enforcement in the pharmacy area.

Medicare Part D More Difficult to Prosecute

Since Medicare Part D payments are capitated, instead of being fee-for-service, prosecuting in this area can be more difficult to prosecute than other areas of Medicade, according to Patrick Burns, co-director of the Taxpayers Against Fraud Education Fund.

Tony Maida, a former deputy chief of the administrative and civil remedies branch of HHS’ Office of Inspector General, also noted in a statement that the announcement Thursday “was packaged together by the government to create a high level of media and public exposure, as well as for a deterrent effect.”

Types of Charges Against the 243 Individuals

In this latest federal effort to crack down on fraud, the 243 individuals accused were charged with a variety of crimes including “conspiracy to commit healthcare fraud, violating the anti-kickback statute, money laundering and aggravated identity theft in areas including home healthcare, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy fraud.”

Who’s Investigating These Cases?

Medicare Strike Force teams from the Fraud Section of the Justice Department’s Criminal Division as well as U.S. attorney’s offices around the country are prosecuting and investigating these cases.